Lisfranc fractures occur in the midsection of the foot and are common in soccer and football players. They can be difficult to diagnose and may require surgery or a cast for treatment. Neglecting treatment can lead to joint degeneration and nerve and blood vessel damage.
A Lisfranc fracture is a fracture or dislocation that occurs in the midsection of the foot, specifically in a group of five long bones collectively called the metatarsals. Also called metatarsal bones, these structures provide bridging stability between the toes in the front and the skeletal mid-back portion of the foot known as the tarsus. The metatarsal bones, with the exception of the first and second metatarsals, are bound together by connective tissue. Dropping something on the foot or twisting it into a hole are two of the most common ways Lisfranc fractures can occur. It is a common foot injury among soccer and football players.
The Lisfranc fracture is named after Jacques Lisfranc de St. Martin, a French surgeon and gynecologist who once worked in the army under Napoleon’s command. The labeling was connected with his description of an injury sustained by soldiers when they fell from their horses, twisting their feet caught in the stirrups. Indeed, Lisfranc was known for his extensive work on fracturing operations. Also named after him is the Lisfranc joint, a set of joints between the forefoot and midfoot also known as the tarsometatarsal joint.
Lisfranc’s foot injury is divided into three classifications. The ipsilateral injury involves displacement of all five metatarsal bones or suggests a cube fracture. The isolated type involves only one or two metatarsals displaced from the other three long bones. With divergent injuries, the bones are moved left and right or forward and backward. The divergent type of Lisfranc fracture can also suggest a defect in the navicular bone located in the midfoot, named for its boat-like shape.
People with a Lisfranc fracture usually experience swelling or bruising in their foot. Some injuries are so severe that the patient is unable to place anything on the affected foot. Lisfranc fractures can easily be mistaken for sprains. Persistent ones that remain even after being treated with ice packs and rest can confirm the injury.
The Lisfranc fracture is very difficult to diagnose using X-rays. Orthopedists, however, can determine its presence if the patient’s sprain produces severe pain when moving the foot in a circular motion. Computed tomography (CT) scans and some types of magnetic resonance imaging (MRI) techniques are used to confirm a Lisfranc fracture.
People with less severe injuries are given a cast to wear for six to eight weeks, after which the orthopedic surgeon replaces them with a fixed orthotic. In more extreme cases, the patient would need surgery, with pins, wires or screws used to stabilize and hold the metatarsals together for optimal healing. In all cases, patients are prohibited from putting weight on the treated foot for a certain period of time, and foot exercises are performed to rehabilitate it to full health. Lack of diagnosis or treatment could have dire consequences such as joint degeneration and damage to nerve cells and blood vessels.
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